Int J Med Inform - User experiences with different regional health information exchange systems in Finland.


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RPOSE: The interest in cross-organizational Health Information Exchange (HIE) is increasing at regional, national and cross-European levels. The purpose of our study was to compare user experiences (usability) of different regional health information exchange system (RHIE) types as well as the factors related to the experienced level of success of different RHIE system types.METHODS: A web-based questionnaire was sent to 95% of Finnish physicians aged between 25 and 65 years of age. RHIE systems were mainly available in the public sector and only in certain regions. Those 1693 physicians were selected from the 3929 respondents of the original study, who met these criteria. The preferred means (paper/fax vs. electronic) of cross-organizational HIE, and replies to the 11 questions measuring RHIE success were used as the main dependent variables.RESULTS: Two thirds (73%) of the primary care physicians and one third (33%) of the specialized care physicians replied using an electronic RHIE system rather than paper or fax as a primary means of cross-organizational HIE. Respondents from regions where a regional virtual EHR (type 3) RHIE system was employed had used electronic means rather than paper HIE to a larger extend compared to their colleagues in regions where a master patient index-type (type 1) or web distribution model (type 2) RHIE system was used. Users of three local EHR systems preferred electronic HIE to paper to a larger extend than users of other EHR systems. Experiences with an integrated RHIE system (type 3) were more positive than those with other types or RHIE systems.CONCLUSIONS: The study revealed User preferences for the integrated virtual RHIE-system (type 3) over the master index model (type 1) or web distribution model (type 2). Success of individual HIE tasks of writing, sending and reading were impacted by the way these functionalities were realized in the EHR systems. To meet the expectations of increased efficiency, continuity, safety and quality of care, designers of HIE systems also need to take into account the different HIE needs of primary care clinicians and their secondary care colleagues in hospitals. Both national legislation and local interpretations of data protection possibly hinder the full use of any RHIE systems. These findings should be taken into account when designing usable HIE systems. More qualitative research is needed on specific features of those local systems that are associated with positive or negative user experience.

Resumo Limpo

rpose interest crossorganiz health inform exchang hie increas region nation crosseuropean level purpos studi compar user experi usabl differ region health inform exchang system rhie type well factor relat experienc level success differ rhie system typesmethod webbas questionnair sent finnish physician age year age rhie system main avail public sector certain region physician select respond origin studi met criteria prefer mean paperfax vs electron crossorganiz hie repli question measur rhie success use main depend variablesresult two third primari care physician one third special care physician repli use electron rhie system rather paper fax primari mean crossorganiz hie respond region region virtual ehr type rhie system employ use electron mean rather paper hie larger extend compar colleagu region master patient indextyp type web distribut model type rhie system use user three local ehr system prefer electron hie paper larger extend user ehr system experi integr rhie system type posit type rhie systemsconclus studi reveal user prefer integr virtual rhiesystem type master index model type web distribut model type success individu hie task write send read impact way function realiz ehr system meet expect increas effici continu safeti qualiti care design hie system also need take account differ hie need primari care clinician secondari care colleagu hospit nation legisl local interpret data protect possibl hinder full use rhie system find taken account design usabl hie system qualit research need specif featur local system associ posit negat user experi

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